Gastrointestinal tract anastomoses with the biofragmentable anastomosis ring: is it still a valid technique for bowel anastomosis? Analysis of 203 cases and review of the literature

Abstract

PurposeBiofragmentable anastomosis ring (BAR) is an alternative to manual and stapled anastomoses performed within the upper and lower gastrointestinal (GI) tract. The aim of this study was to evaluate the effectiveness of BAR utility for bowel anastomoses based on our own material.MethodsA retrospective analysis was performed to a total of 203 patients who underwent bowel surgery with the use of BAR anastomosis within upper and lower gastrointestinal tract between 2004 and 2014. Data for the analysis was collected based on medical records, treatment protocols, and the results of histological examinations.ResultsThe study group consisted of 86 women and 117 men. The most common underlying pathology was a malignant disease (n = 165). Biofragmentable anastomosis ring (BAR) size 31 was the most commonly used (n = 87). A total of 169 colocolic or colorectal anastomoses and 28 ileocolic and 8 enteroenteric anastomoses were performed. The mortality rate was 0.5 % (n = 1) whereas re-surgery rate within 30 days was 8.4 % (n = 17). Twenty-eight patients developed perioperative complications with surgical site infection as the most common one (n = 11). Eight patients developed specific complications associated with BAR including an anastomotic leak (n = 6) and intestinal obstruction (n = 2). The mean time of hospital stay after surgery was 12.7 days.ConclusionsThe use of BAR for the GI tract anastomoses is simple and rapid method and it is characterized with an acceptable number of perioperative mortality and complication rates. Based on our experience, we recommend the use of BAR anastomosis in different types of intestinal anastomosis in varying clinical scenarios.

Systematic Review and Meta-Analysis on Colorectal Anastomotic Techniques

“…Furthermore, it has been shown that compression anastomoses can potentially be compared with conventional and staple suturing techniques in terms of safety and surgical outcome, or in some cases even produce better results. 32 , 35 , 36 , 38 , 77 , 86 , 95 , 96 Especially, the expulsion of the compression implants enabling a foreign-body-free healing process, leading to less scarring, deserves notice. In their meta-analysis, however, Slesser et al concluded that there were no advantages with regard to postoperative complications in favor of compression anastomoses 15 and our meta-analysis also did not provide any evidence of superiority.…”

Compression automation of circular stapler for preventing compression injury on gastrointestinal anastomosis

“…Automatic devices for providing uniform anastomosis by reducing operator dependence are continuously being studied to reduce the anastomotic complications. Representatively, methods using a magnet such as Magnamosis or using a bio fragment ring (BAR) can avoid the user's deviation from the compression pressure 15,16 . However, in cases of Magnamosis using magnets or the BAR, it is difficult to adjust the compression force depending on the tissue condition and expected recovery characteristics; moreover, it is impossible to use such approaches in the low rectum 17 .…”

“…Representatively, methods using a magnet such as Magnamosis or using a bio fragment ring (BAR) can avoid the user's deviation from the compression pressure. 15 , 16 However, in cases of Magnamosis using magnets or the BAR, it is difficult to adjust the compression force depending on the tissue condition and expected recovery characteristics; moreover, it is impossible to use such approaches in the low rectum. 17 Heretofore, circular staplers were usually applied for colorectal surgery and that was based on the operator's dependent manual compression.…”

Experimental Procedure of Compression Anastomosis Using Fragmented Rings: A Porcine Model

“…This technique is still an attractive alternative to other types of bowel anastomoses even a persistent intestinal obstruction risk. 34 We advocate practicing with fragmented rings before surgery to avoid this risk. This practice strategy has been used with Anastocom, and it should reduce the rate of postoperative obstruction due to nonexpulsion.…”